The health secretary has made an intriguing start in a tough job, by styling himself a patients’ champion

BRITONS are proud of the National Health Service, but their affections are being sorely tested. Last July a coroner ruled that a man had died of thirst in St George’s Tooting, a big London hospital. A television documentary exposed systematic cruelty in a care home contracted by the NHS, leading to convictions. Later this month Robert Francis, a barrister, will conclude a report into malpractice and neglect at a Staffordshire hospital between 2005 and 2009. Up to 1,200 patients are thought to have died unnecessarily there.

This bleak catalogue might seem to pile yet more misery on the coalition. Health is perhaps its weakest point. Reforms launched in 2010 aimed at expanding the responsibilities of family doctors and encouraging more private-sector involvement. But they seemed to require much upheaval for uncertain rewards, and met huge opposition. Watered-down plans are being implemented, without fanfare.

David Cameron had soothed concerns about Conservative intentions towards the NHS before the 2010 election by promising to protect the service from outright cuts. Still, Labour’s lead on health in opinion polls has roughly doubled since he became prime minister. And the Nuffield Trust, a health think-tank, warns that real-terms budget cuts of £4 billion ($6.5 billion) between 2011 and 2015 will begin to affect patients’ experience this year.

Into this cauldron steps Jeremy Hunt, the recently appointed health secretary. He has started intriguingly, by identifying strongly with patients’ anxieties and pledging to act as their defender in a system where bureaucracy often shields individuals from blame. His solution to what he calls a “crisis in the standards of care” includes a proposal that the health service emulate Ofsted, which inspects schools. Weaker hospital management trusts might be taken over by proven leaders, on the model of school “superheads”.

A cynic might conclude that Mr Hunt is getting ahead of grievances by siding with complaints which are likely to multiply as cuts bite. The newcomer has signalled that managers who mess up should be removed more ruthlessly. Even such big beasts as Sir David Nicholson, chief executive of the NHS, might be in the firing line when the Mid Staffordshire report is published. Sir David has already conceded that the NHS’s managers “lost the plot” in the past few years, because they were too buried in the detail of complicated reforms.

Mr Hunt also wants greater emphasis on technology to help patients decipher what is good and bad in the service (present data is often vague or difficult for laymen to decipher). He is backing an initiative to release more information about the performance of hospitals. Indicators like how respectfully patients feel they have been treated correlate with wider medical outcomes, he says, and should be taken more seriously by managers.

Yet the health secretary cannot escape a central contradiction. The reforms of the last decade have created bodies ranging from family doctor commissioning groups, foundation hospital trusts which run their own affairs and Monitor, the powerful standards regulator. All of these are intended to create an NHS led by clinicians, not meddled with by politicians.

The days when Aneurin Bevan, the founder of the post-war health service, ordained that the “sound of a dropped bedpan” in a provincial hospital should be heard in Westminster are over. Politicians who want to make changes to the health-care system must now do so through winning public arguments against entrenched interests, setting priorities and acting as megaphones for urgent causes. Despite its name, they no longer have absolute power over the National Health Service. The bully pulpit will have to do instead.